Home About us Contact
|
Home About us Contact | ||
|
|
||
Leg Ulcers (leg + ulcer)
Kinds of Leg Ulcers Terms modified by Leg Ulcers Selected AbstractsLeg Ulcer in Hereditary SpherocytosisPEDIATRIC DERMATOLOGY, Issue 5 2003Susana Giraldi M.D. We report a 13-year-old girl with hereditary spherocytosis who developed a chronic painful ulcer on the medial malleolus. All other etiologies were ruled out. Nine months after splenectomy the ulcer healed completely and the symptoms disappeared. We discuss and review this unusual entity in children. [source] Letter: The Use of a Dermal Substitute and Thin Skin Grafts in the Cure of "Complex" Leg UlcersDERMATOLOGIC SURGERY, Issue 3 2010ROY RINDLER MD No abstract is available for this article. [source] Serum Iron and Matrix Metalloproteinase-9 Variations in Limbs Affected by Chronic Venous Disease and Venous Leg UlcersDERMATOLOGIC SURGERY, Issue 6 2005Paolo Zamboni MD Background. Severe chronic venous disease (CVD) is characterized by both dermal hemosiderin accumulation and matrix metalloproteinase (MMP) hyperactivation. The iron-driven pathway is one of the recognized mechanisms of MMP hyperactivation. Objective. To investigate the potential consequences of leg hemosiderin deposits on both iron metabolism and activation of MMPs. Methods. We contemporaneously assessed the following in the serum of the arm and ankle veins of 30 patients (C4,6) with CVD and 14 normal subjects: ferritin, transferrin, iron, percentage of transferrin iron binding capacity (%TIBC), and MMP-9. Optical microscopy examinations with Perls' staining of chronic wounds were also performed. Results. Histology consistently revealed iron deposits. Serum ferritin, iron, and %TIBC were significantly increased in the legs affected by severe CVD compared with the arm of the same subjects or the controls. In addition, iron and %TIBC were significantly elevated in the legs of ulcer patients. The rate of activation of MMP-9 was significantly elevated in CVD. Conclusions. The increased iron deposition in legs affected by CVD seems to be more instable in ulcer patients, leading to iron release in the serum of the affected leg. Our data suggest the iron-driven pathway as a further mechanism for MMP hyperexpression leading to tissue lesion. [source] Leg ulcers and hydroxyurea: report of three cases with essential thrombocythemiaINTERNATIONAL JOURNAL OF DERMATOLOGY, Issue 12 2002Zeynep Demirçay MD Case 1,A 65-year-old woman with essential thrombocythemia (ET) had been taking oral hydroxyurea (HU), 1000 mg daily, for 7 years. Six months ago, she developed an ulcer on the outer part of her left ankle, which healed spontaneously within 2 months. She presented with a new, tender, shallow ulcer, 2 cm × 2 cm in size, at the same site. Doppler examination revealed thrombosis of the left common femoral vein and a calcified atheroma plaque of the left common femoral artery. The dosage of HU was decreased to 500 mg daily when the platelet counts were found to be within normal levels. The ulcer completely healed within 2 months with occlusive wound dressings, and has not recurred within the follow-up period of 1 year. Case 2,A 56-year-old women presented with multiple, painful, leg ulcers of 1 year duration. She had been diagnosed as having ET and had been on HU therapy, 1500 mg/day, for the past 5 years. Interferon-,-2b was started 3 months ago, in addition to HU, which was tapered to 1000 mg daily. She had suffered from hypertension for 20 years treated with nifedipine and enalapril, and had recently been diagnosed with diabetes mellitus which was controlled by diet. Examination revealed three ulcers located on the lateral aspects of both ankles and right distal toe. Arterial and venous Doppler examinations were within normal limits. Histopathology of the ulcer revealed nonspecific changes with a mixed inflammatory cell infiltrate around dermal vessels. The ulcers completely healed within 10 weeks with topical hydrocolloid dressings. After healing, she was lost to follow-up. A year later, it was learned that she had developed a new ulcer at her right heel, 3 months after her last visit (by phone call). This ulcer persisted for 8 months until HU was withdrawn. Case 3,A 64-year-old woman with ET presented with a painful leg ulcer of 6 months' duration. She had been taking oral HU for 5 years. She had a 20-year history of hypertension treated with lisinopril. Examination revealed a punched-out ulcer of 2 cm × 2 cm over the right lateral malleolus (Fig. 1). Doppler examination of the veins revealed insufficiency of the right greater saphenous and femoral veins. Angiography showed multiple stenoses of the right popliteal and femoral arteries. As her platelet count remained high, HU was continued. During the follow-up period of 13 months, the ulcer showed only partial improvement with local wound care. Figure 1. Punched-out ulcer surrounded by an erythematous border over the right malleolus (Case 3) [source] Leg ulcers in sickle cell disease,,AMERICAN JOURNAL OF HEMATOLOGY, Issue 10 2010Caterina P. Minniti No abstract is available for this article. [source] Sickle cell leg ulcers: a frequently disabling complication and a marker of severityBRITISH JOURNAL OF DERMATOLOGY, Issue 2 2008M. Halabi-Tawil Summary Background, Leg ulcers are a poorly known and underestimated complication of sickle cell disease (SCD), but in our experience they often appear as a severely disabling condition, associated with the most severe forms of the disease. Objectives, To assess the characteristics, complications, repercussion on quality of life and associations of SCD ulcers. Methods, Case series of 20 patients followed in a French referral centre for SCD and who had previous/present leg ulcers. Results, Median ulcerated area was 12 cm² and median time spent with ulcers was 29·5 months. Locoregional infections developed in 85%, ankle stiffness in 50% and mood disorders in 85%. Ninety per cent of patients needed analgesics, 20% being opioids. Median loss of time from work was 12·5 months. The Short Form 36 Health Survey showed physical and mental component summary scores of 41·5 and 40·7, respectively, indicating severe alteration close to that found in lung cancer or haemodialysis. Two categories of SCD leg ulcers were distinguished, defined by a 1-year duration cut off. The ,prolonged' ulcers had larger surfaces, tended to recur more frequently and led to more infection and depression. Several SCD complications were associated with leg ulcers, notably priapism, pulmonary hypertension, stroke and acute chest syndrome. Conclusions, Leg ulcers are a major complication of SCD, given their severe consequences and frequent association with other specific organ damage, and they constitute in their ,prolonged' form a severely disabling condition that remains an important therapeutic challenge. [source] Characterization of the polysensitized patient: a matched case,control studyCONTACT DERMATITIS, Issue 1 2009Berit Christina Carlsen Background: Polysensitization ( , 3 contact allergies) may be regarded as a special entity in patients with contact allergies. However, this group of polysensitized patients is poorly characterized. Filaggrin mutations are associated with atopic eczema and lead to impaired skin barrier which may predispose to contact allergy. Therefore, it is of interest to consider atopic eczema and contact allergies, especially in patients with multiple allergies. Objective: To characterize polysensitized patients regarding occurrence, duration and course of dermatitis, and examine potential risk factors for polysensitization, including atopic eczema. Methods: A questionnaire case,control study of 562 polysensitized and 1124 single/double-sensitized individuals was performed. Results: The results show that 45% of polysensitized and 31% of single/double-sensitized patients had or had had atopic eczema, and atopic eczema was identified as a risk factor for polysensitization. Patients with leg ulcer constituted only a minor part of the polysensitized group and leg ulcers were not identified as a risk factor for polysensitization in this study. The influence of contact allergies on duration and course of disease diverged between the group of patients with atopic eczema and the group without atopic eczema. Conclusion: Patients with atopic eczema were overrepresented in the group of polysensitized patients and polysensitized patients should be viewed in the light of occurrence or lack of atopic eczema. [source] Cd8+/v,5.1+ large granular lymphocyte leukemia associated with autoimmune cytopenias, rheumatoid arthritis and vascular mammary skin lesions: successful response to 2-deoxycoformycin.HEMATOLOGICAL ONCOLOGY, Issue 2 2002E. Granjo Abstract We report a case of CD8+/V,5.1+ T-cell large granular lymphocyte leukemia (T-LGL leukemia) presenting with mild lymphocytosis, severe autoimmune neutropenia, thrombocytopenia, polyarthritis and recurrent infections with a chronic disease course. Immunophenotyping showed an expansion of CD3+/TCR,,+/CD8+bright/CD11c+/CD57,/CD56, large granular lymphocytes with expression of the TCR-V,5.1 family. Southern blot analysis revealed a clonal rearrangement of the TCR ,-chain gene. Hematopoietic growth factors, high dose intravenous immunoglobulin and corticosteroids were of limited therapeutic benefit to correct the cytopenias. During the disease course, the patient developed a severe cutaneous leg ulcer and bilateral vascular mammary skin lesions. Treatment with 2-deoxycoformycin resulted in both clinical and hematological complete responses, including the resolution of vascular skin lesions. Combined immuno-staining with relevant T-cell associated and anti-TCR-V, monoclonal antibodies proved to be a sensitive method to assess the therapeutic effect of 2-deoxycoformicin and to evaluate the residual disease. Copyright © 2002 John Wiley & Sons, Ltd. [source] Leg ulcers and hydroxyurea: report of three cases with essential thrombocythemiaINTERNATIONAL JOURNAL OF DERMATOLOGY, Issue 12 2002Zeynep Demirçay MD Case 1,A 65-year-old woman with essential thrombocythemia (ET) had been taking oral hydroxyurea (HU), 1000 mg daily, for 7 years. Six months ago, she developed an ulcer on the outer part of her left ankle, which healed spontaneously within 2 months. She presented with a new, tender, shallow ulcer, 2 cm × 2 cm in size, at the same site. Doppler examination revealed thrombosis of the left common femoral vein and a calcified atheroma plaque of the left common femoral artery. The dosage of HU was decreased to 500 mg daily when the platelet counts were found to be within normal levels. The ulcer completely healed within 2 months with occlusive wound dressings, and has not recurred within the follow-up period of 1 year. Case 2,A 56-year-old women presented with multiple, painful, leg ulcers of 1 year duration. She had been diagnosed as having ET and had been on HU therapy, 1500 mg/day, for the past 5 years. Interferon-,-2b was started 3 months ago, in addition to HU, which was tapered to 1000 mg daily. She had suffered from hypertension for 20 years treated with nifedipine and enalapril, and had recently been diagnosed with diabetes mellitus which was controlled by diet. Examination revealed three ulcers located on the lateral aspects of both ankles and right distal toe. Arterial and venous Doppler examinations were within normal limits. Histopathology of the ulcer revealed nonspecific changes with a mixed inflammatory cell infiltrate around dermal vessels. The ulcers completely healed within 10 weeks with topical hydrocolloid dressings. After healing, she was lost to follow-up. A year later, it was learned that she had developed a new ulcer at her right heel, 3 months after her last visit (by phone call). This ulcer persisted for 8 months until HU was withdrawn. Case 3,A 64-year-old woman with ET presented with a painful leg ulcer of 6 months' duration. She had been taking oral HU for 5 years. She had a 20-year history of hypertension treated with lisinopril. Examination revealed a punched-out ulcer of 2 cm × 2 cm over the right lateral malleolus (Fig. 1). Doppler examination of the veins revealed insufficiency of the right greater saphenous and femoral veins. Angiography showed multiple stenoses of the right popliteal and femoral arteries. As her platelet count remained high, HU was continued. During the follow-up period of 13 months, the ulcer showed only partial improvement with local wound care. Figure 1. Punched-out ulcer surrounded by an erythematous border over the right malleolus (Case 3) [source] Use of the sensory nerve stimulator to accelerate healing of a venous leg ulcer with sensory nerve dysfunction: a case studyINTERNATIONAL WOUND JOURNAL, Issue 3 2005Article first published online: 7 SEP 200 Utilisation d'un stimulateur nerveux sensitif pour accélerer la cicatrisation des ulcères veineux avec dysfonctionnement nerveux sentitif: à propos d'un cas Un nouveau traitement utilisant la stimulation nerveuse sensitive (International Patent Appliction Number PCT/AU2004/001079 , nerve dysfunction and tissue healing"(Khalil Z) a été développé dans notre laboratoire de physiologie vasculaire. Ce traitemeent a montré une amélioration de la fonction nerveuse sensitive et les déficiences en cicatrisation associées chez des personnes agées par rapport à des personnes jeunes. Un homme de 82 ans présentant un ulcère de jambe petit mais persistant depuis 18 mois, en dépit d'un traitement approprié en pansements et en contention., a été vu dans un service specialisé en traitement des plaies. Les functions sensitives et microvasculaires etaient évaluées avec beaucoup de details gràce à l'utilisation de techniques de laboratoire de physiologie vasculaire, et il a bénéficié d'un traitement par stimulation en complément d'un traitement conventionnel. Sa plaie a cicatrisé après 4 semaines. Nous rapportons ce cas ici. Avant traitement par stimulation nerveuse, la sensation cutanée, le flux sanguin microcirculatoire et la tension d'oxygène ont été trouvées diminuées près de l'ulcère en comparaison avec le membre oppose non ulcéré. Après traitement, la tension d'oxygène et la flux sanguin microcirculatoire étaient améliorés. Ce cas apporte une preuve supplémentaire que le traitement par stimulation nerveuse sensitive dans des conditions bien définies améliore la cicatrisation. L'observation d'une amélioration de la fonction nerveuse sensitive supporte la nition qu'une amélioration de la cicatrisation est liée à une amélioration de la fonction nerveuse. Anwendung eines sensiblen Nervenstimulationsgerätes zur beschleunigten Wundheilung eines venösen Beinulcus mit begleitender neurologischer Dysfunktion: eine Fallstudie Eine neue Therapieform zur Stimulation der Nervensensibilität wurde in den eigenen Laboratorien entwickelt. Diese Behandlungsform zeigte eine Verbesserung der insbesondere bei älteren Patienten vorliegenden eingeschränkten Nervenfunktion und der damit verbundenen verzögerten Wundheilung. Wir berichten über den Fall eines 82 jährigen Patienten mit einem kleinen, über 18 Monaten persistierenden venösen Ulkus am Unterschenkel trotz Anwendung verschiedener Wundauflagen und einer begleitenden Kompressionsbehandlung. In unserem Labor wurden unter Anwendung vaskulärerer und physiologsicher Messungen die Sensibilität und die mikrovaskuläre Funktion erfasst und eine Nervenstimulationstherapie in Verbindung mit Wundauflagen und Kompressionsbehandlung durchgeführt. Die Wundheilung war nach 4 Wochen abgeschlossen. Vor der Nervenstimulationstherapie war die Hautsensibilität, der mikrovaskuläre Blutfluss sowie der Sauerstoffdruck im Gewebe im Vergleich zur gesunden Gegenseite vermindert. Nach der Therapie zeigten sich alle drei Parameter verbessert. Dieser Fall stellt einen weiteren Beweis dar, dass eine zusätzliche Nervenstimulation zu den etablierten Behandlungsstrategien die Wundheilung positiv beeinflusst. Die Beobachtung dass sich die sensible Nervenfunktion verbessert hat lässt zusätzlich den Schluss zu, dass eine Optimierung der Wundheilung auch durch eine verbesserte Nervenfunktion erreicht wird. Impiego della stimolazione di nervi sensoriali per accelerare la guarigione di ulcere venose della gamba con disfunzione dei nervi sensoriali: studio di un caso Nel nostro laboratorio di fisiologia vascolare è stata sviluppata una nuova terapia che utilizza la stimolazione dei nervi sensoriali (brevetto internazionale di applicazione numero: PCT/AU2004/001079: riparazione del tessuto e della funzione del nervo (Khalil, Z). Questo trattamento ha mostrato di migliorare la carente funzione dei nervi sensoriali e la ridotta riparazione tessutale di ferite in persone anziane se paragonate ai livelli di guarigione di persone giovani.. Un uomo di 82 anni con una piccola ma persistente ulcera delle gambe presente da 18 mesi, nonostante un apparente ed appropriato trattamento con medicazioni e compressione, è stato visitato in un servizio specialistico per la cura delle ferite. Le funzioni sensoriali del paziente e la microcircolazione sono state monitorizzate in grande dettaglio utilizzando le tecniche del laboratorio di fisiologia vascolare, ed è stata fornita la terapia di stimolazione dei nervi sensoriali in aggiunta alla terapia convenzionale.. La sua ferita è guarita in quattro settimane. Noi riportiamo qui un caso. Prima del trattamento con stimolazione dei nervi, sono state riscontrate ridotte la sensibilità cutanea, il flusso ematico microcircolatorio e la tensione di ossigeno vicino alla lesione ulcerativa, se comparate con la sede controlaterale non ulcerata. Dopo la terapia, la tensione di ossigeno ed il flusso microcircolatorio sono migliorati. Questo caso fornisce una ulteriore evidenza che la terapia con stimolazione del sensorio migliora la riparazione tessutale di ferite seguendo determinati parametri. L'osservazione di una migliore funzione sensoriale fornisce supporto per la nozione che una migliore riparazione tessutale è mediata da una migliore funzionalità dei nervi. Uso del estimulador nervioso sensitivo para acelerar la cicatrización de una úlcera vascular venosa con disfunción nerviosa sensitiva: estudio de un caso En nuestro laboratorio de fisiología vascular se ha desarrollado un nuevo tratamiento basado en la estimulación nerviosa sensitiva [Número de Solicitud de Patente Internacional: PCT/AU2004/001079: ,Función nerviosa y cicatrización tisular"(Khalil, Z)]. Se ha comprobado que este tratamiento mejora la función nerviosa sensitiva deficiente y la subsiguiente curación deficiente de heridas en personas de edad avanzada hasta alcanzar los niveles observados en personas jóvenes. En un servicio de tratamiento de heridas especializado se visitó a un hombre de 82 años con una úlcera vascular venosa pequeña, pero persistente durante 18 meses a pesar de la aplicación de apósitos aparentemente apropiados y tratamiento compresivo. Se evaluaron muy por debajo las funciones sensitiva y microvascular del paciente por medio de técnicas de laboratorio de fisiología vascular y se le aplicó tratamiento de estimulación nerviosa sensitiva además de tratamiento convencional. Su herida curó al cabo de 4 semanas. En este artículo describimos el caso. Antes de proceder al tratamiento de estimulación nerviosa se comprobó que la sensibilidad cutánea, el flujo sanguíneo microvascular y la concentración de oxígeno estaban reducidos en la proximidad de la úlcera en comparación con la pierna contralateral, no ulcerada. Después del tratamiento, la concentración de oxígeno y el flujo sanguíneo microvascular habían mejorado. Este caso proporciona pruebas adicionales de que el tratamiento de estimulación nerviosa sensitiva, con los parámetros especificados, mejora la curación de las heridas. La observación de la mejoría de la función nerviosa sensitiva respalda el concepto de que la mediación de una cicatrización más óptima reside en la mejoría de la función nerviosa. Användandet av känselnerv stimulator för att påskynda läkning av venösa bensår med känselnerv dysfunktion: en fallstudie En ny terapi som använder känselnerv stimulering [Internationellt Patent Ansökningsnummer PCT/AU2004/001079: ,nervfunktion och vävnadsläkning'(Khalil, Z)] har utvecklats i vårt laboratorium för vaskulär fysiologi. Denna behandling har visat sig förbättra försämrad känselnervfunktion och ansluten nedsatt sårläkning hos äldre personer till nivåer iakttagna hos yngre personer. En 82-årig man med ett litet venöst bensår som emellertid fortbestått i 18 månader, trots klart tillbörliga sårförband och kompressionsterapi, sågs på en specialist sårvårdsmottagning. Patientens känslofunktion och mikrovskulära funktion undersöktes ingående med hjälp av vaskulärfysiologiska laboratorie tekniker, och han erhöll känselnerv stimuleringsterapi samt konventionell terapi. Hans sår läktes efter 4 veckor. Vi rapporterar detta fall här. Jämfört med det andra sårfria benet iakttogs i området runt såret nedsatt känsla i huden, nedsatt mikrovaskulärt blodflöde och syre tryck före insättandet av nervstimuleringsterapi. Efter terapin hade syretrycket och mikrovaskulära blodflödet förbättrats. Denna fallstudie utgör ett ytterligare bevis för att känselnerv stimuleringsterapi förbättrar sårläkning i de parameter som stipulerats. Observationen att känselnervfunktionen förbättrades utgör ett stöd för uppfattningen att förbättrad nervfunktion åstadkommer förbättrad sårläkning. [source] Changes in quality of life for patients with chronic venous insufficiency, present or healed leg ulcersJOURNAL DER DEUTSCHEN DERMATOLOGISCHEN GESELLSCHAFT, Issue 11 2009Regina Renner Summary Background: Patients with chronic leg ulcers are handicapped in daily life, both by physical complaints and social problems. The aim of our study was not only to assess a possible impairment of quality of life (QOL) of leg ulcer patients but also to evaluate if there is a real improvement of QOL after healing of the ulcer. Patients with chronic venous insufficiency served as the control group. We further analyzed if there were significant differences in the response between patients who were and were not performing compression therapy. Patients and method: We interviewed three groups of patients (active venous leg ulcer, healed venous leg ulcer and patients with chronic venous insufficiency using the ,Freiburger Life Quality Assessment für Venenerkrankungen" (FLQAv). Results: Physical problems, daily handicaps and social problems all increased with age. Contrary to our expectations, healing of a leg ulcer did not lead to a significant increase in QOL. Instead, patients with active ulcers did not regard their QOL as lower than those in the other groups. Compression therapy also did not impair QOL in the three groups. Conclusion: Even though ulcer healing is an admirable goal, it does not necessarily lead to an improved QOL, probably because of the numerous comorbidi-ties in this patient group. Nonetheless, it is important to control problems associated directly with the wound to allow ulcer patients to participate actively in everyday life and minimize social problems. [source] How evidence-based is venous leg ulcer care?JOURNAL OF ADVANCED NURSING, Issue 2 2009A survey in community settings Abstract Title.,How evidence-based is venous leg ulcer care? A survey in community settings. Background:, Incongruence between evidence and practice in leg ulcer care has been reported. Little is known about predictive factors related to the provision of lifestyle advice. Method:, Two focus interviews and a Delphi procedure were used to develop a self-administered questionnaire based on the Graham questionnaire. Nurses employed by community healthcare organizations and independent nurses in private practices participated (n = 789). The data were collected in 2006. Findings:, Compression was applied in 58·7% of patients with venous ulcers. Pain was present in 82·9%. A third of patients with pain received analgesics, but half of these patients (52·1%) took analgesics as prescribed. Half of the nurses (50·8%) gave lifestyle advice related to the leg ulcer. It was mainly instructions about leg elevation (68·3%), promoting physical activity (39·8%) and optimizing nutrition (16·7%) that were provided. Nurses who perceived themselves to have adequate leg ulcer knowledge and skills were 3·75 times more likely to provide lifestyle advice compared with those lacking such knowledge and skills. Nurses who found leg ulcer care not rewarding, rarely successful or difficult gave statistically significantly less lifestyle advice than those who found it rather rewarding, successful and not difficult. Conclusion:, Patients with leg ulcers receive less than optimum care and patient education. A particular challenge lies in leg ulcer education programmes and pain management. [source] Arteriolosclerotic ulcer of MartorellJOURNAL OF THE EUROPEAN ACADEMY OF DERMATOLOGY & VENEREOLOGY, Issue 8 2010JDD Vuerstaek Abstract In 1945, Martorell described ischaemic leg ulcers in patients with hypertension. He suggested that the ischaemic necrosis was secondary to a hypertensive arteriolar disease and referred to them as ,hypertensive ischaemic ulcers'. In recent years, the specific entity of these ulcers has been questioned. Others claim they have a much higher incidence, but presume the diagnosis is frequently missed. Almost 900 cases of Martorell's ulcers have been reported in literature since the first description. A systematic review and comprehensive search of literature (evidence-based) was needed to characterize this type of ulcer. Based on aetiology and histopathology, it seems to be justified to maintain the name ,arteriolosclerotic ulcer of Martorell'. We conclude that the arteriolosclerotic ulcer of Martorell is a specific entity with its own clinical and histological diagnostic keys, wound management and preventive measures. We introduce a set of criteria that may be used to facilitate diagnosing arteriolosclerotic ulcer of Martorell as well as a flowchart that includes diagnosis, treatment and prevention of this particular type of vascular leg ulcer. [source] Classification and design of teledermatology practice: What dermatoses?JOURNAL OF THE EUROPEAN ACADEMY OF DERMATOLOGY & VENEREOLOGY, Issue 8 2009Which technology to apply? Abstract Dermatologists are mostly confined to urban regions and rural population is deprived of specialist care. Teledermatology Practice (TDP) is a solution to overcome this global problem. Tools for TDP includes video conference, store and forward, hybrid, mobile, satellite communication, integration model, nurse-led teledermatology, teledermatology focusing on difficult-to-manage cases, teledermoscopy, and teledermatopathology with combined applications. This article reviews the feasibility studies focusing teledermatology tools and analyses the possible options in designing TDP. Categorizing dermatoses for TDP depends on the purpose and types of technology. The dermatoses presenting from a remote geographic regions requires any of the following approaches (i) only TDP, (b) initial TDP followed by face-to-face, (iii) initial face-to-face followed by TDP and (iv) only face-to-face examination. The technology should suit the dermatoses, meet the purpose, be cost-effective and provide better management with follow-up care. We recommend store and forward as a basic TDP model as most dermatoses are diagnosed and follow-up care is delivered. Leprosy, pigmented skin lesions, leg ulcers, HIV and endemic dermatoses require screening and triage services using mobile teledermatology. Counselling and education require videoconference. Rural dermatology's camps require satellite communication mounted on a vehicle. Objective assessment (vitiligo and leg ulcer) after treatment requires integration model at a tertiary centre. Difficult-to-manage cases require second opinion using hybrid/store and forward TDP. Lower rural centre are provided with mobile/ store and forward teledermatology services. Selected or major community centre should be equipped with hybrid teledermatology and linked to a tertiary centre. This process helps healthcare administration to plan a TDP to cover all dermatoses, utilizing the available health care professional (HCP) and technology with minimum budget investment. Conflicts of interest None declared. [source] Is there an easier way to autograft skin in chronic leg ulcers? ,Minced micrografts', a new techniqueJOURNAL OF THE EUROPEAN ACADEMY OF DERMATOLOGY & VENEREOLOGY, Issue 10 2008P Boggio Abstract Background Chronic venous leg ulcers represent an urgent and increasing problem for public health. The use of skin autografts results in a greater therapeutic success in healing chronic ulcers. Objective A simple method of skin autografting that could permit a wider use of skin grafts in outpatients is needed. A new technique allowing skin autografting in a simple one-step process, without complex surgical procedures or expensive technical supplies, is presented. Methods A small, full-thickness skin specimen taken from the patient is finely minced and spread on his leg ulcer bed allowing to cover a surface many times wider than the sample itself. Results This method induces faster re-epithelization of chronic leg ulcers that failed to heal despite good conservative local therapy and give the possibility to repair very large ulcers with small fragments of skin. A clinical case is shown as an example out of 20 ulcers we recently treated. Conclusion Our preliminary report shows that this technique results in a greater therapeutic success (18 of 20 cases) in healing chronic leg ulcers, a common pathology that often affects outpatients treated for very long periods at home or in the Dermatologist's office. In our experience, this new and successful reparative possibility makes ,mince grafting' a recommendable procedure. [source] Successful treatment of a leg ulcer occurring in a rheumatoid arthritis patient under leflunomide therapyJOURNAL OF THE EUROPEAN ACADEMY OF DERMATOLOGY & VENEREOLOGY, Issue 2 2005J Knab ABSTRACT Objective, We report the case of a leg ulcer in a rheumatoid arthritis (RA) patient under treatment with leflunomide, discuss the influence of the drug on the aetiopathogenesis of the ulcer and describe its successful treatment. Case summary, A 68-year-old woman with a 12-year history of RA developed a leg ulcer after 4 months of leflunomide treatment. Other ulcerogenic factors were ruled out. There were some clinical hints for rheumatoid vasculitis. The ulcer was resistant to ambulant conservative phase adapted wound bed preparation and a split skin transplantation failed. After omission of leflunomide and washout procedure with cholestyramine a second split skin transplantation resulted in complete healing. Discussion, Leflunomide inhibits the division of activated T cells and thus inhibits among others the production of proinflammatory cytokines and the adhesion of cells to the endothelium. These mechanisms may partly explain the possible influence of leflunomide on the perpetuation of the ulcer. Until now, occurrence of vasculitis and leg ulcers has been described in one case each for the novel immunomodulator leflunomide. No successful treatment of a leg ulcer under leflunomide has been described yet. Omission of leflunomide and a washout treatment in our case led to a complete healing. This may indicate a critical role of leflunomide in the maintenance of this slow healing ulcer. Conclusions, An association between leflunomide intake, occurrence of leg ulcers in RA patients and delayed wound healing should be considered. [source] Fear-avoidance beliefs and pain as predictors for low physical activity in patients with leg ulcerPHYSIOTHERAPY RESEARCH INTERNATIONAL, Issue 3 2009Kirsti Skavberg Roaldsen Abstract Background and Purpose.,Previous studies have shown that patients with chronic venous insufficiency are deconditioned and physically inactive. The present study aimed to examine the occurrence of fear-avoidance beliefs in patients with chronic venous insufficiency, and to investigate the role of fear-avoidance beliefs and pain severity in predicting the low level of physical activity in these patients.,Method.,Data were collected by a postal questionnaire sent to 146 patients with chronic venous insufficiency and current or previous venous leg ulcer. Complete data were collected from 98 patients aged 60,85 years , 63% women , giving a response rate of 67%. Fear-avoidance beliefs were assessed by the Fear-Avoidance Beliefs Questionnaire, physical activity subscale. Pain and physical activity were assessed by the Six-point Verbal Rating Scale of Pain Assessment and the Physical Activity Questionnaire, respectively.,Results.,Fear-avoidance beliefs were present in 81 (83%) of the patients with chronic venous insufficiency (range 0,24, median 12). Forty patients (41%) had strong fear-avoidance beliefs. One-third of the patients with healed ulcers had strong fear-avoidance beliefs. Patients with low physical activity had significantly stronger fear-avoidance beliefs and more severe pain than patients with high physical activity. Multiple logistic regression showed that the odds ratio (OR) for low physical activity were about three times higher for patients with strong fear-avoidance beliefs (OR 3.1, 95% confidence interval 1.1,8.3; p = 0.027) than for patients with weak fear-avoidance beliefs.,Conclusions.,Fear-avoidance beliefs were present in most patients with chronic venous insufficiency and were associated with low physical activity. Clinical implications ought to include a better recognition of fear-avoidance beliefs, early information about the negative consequences of such beliefs, and the importance of physical activity to counteract poor mobility. Copyright © 2009 John Wiley & Sons, Ltd. [source] Functional ability in female leg ulcer patients , a challenge for physiotherapyPHYSIOTHERAPY RESEARCH INTERNATIONAL, Issue 4 2006Kirsti Skavberg Roaldsen Abstract Background and Purpose.,Venous leg ulceration represents a global health problem affecting predominantly elderly women. Traditionally, functional problems in this group of patients have attracted modest attention from wound care providers and physiotherapists. The aim of the present study was to describe and quantify disease consequences in female leg ulcer patients as a background for future physiotherapy interventions, using the nomenclature of the WHO International Classification of Functioning, Disability and Health (ICF).,Method.,A prospective study was conducted in 34 women aged 60,85 years with current or previous venous leg ulcer as compared to 27 age-matched non-ulcer subjects. The outcome variables were pain, ankle range of motion, walking speed, walking endurance, self-perceived exertion, mobility, activities of daily living (ADL), physical activity, general health, life satisfaction and use of walking aids and community services. Established instruments were utilized and categorized within ICF domains to provide a conceptual framework and basis for physiotherapeutic research.,Results.,Leg ulcer patients showed significantly reduced values of ankle range of motion, walking speed and endurance, self-perceived exertion, mobility, ADL and physical activity level as compared to control subjects. Patients suffering from active ulceration were more negatively affected, and more of them had pain than post-ulcer fellows. By contrast, general health and life satisfaction were similarly rated by the two study groups.,Conclusions.,Elderly females in our study with chronic leg ulcer of venous aetiology had significant mobility impairments, but the reasons and consequences of these impairments remain to be elucidated. The potential of preventive measures and physical rehabilitation to aid functioning and prospects of leg ulcer repair need to be investigated in future studies. Copyright © 2006 John Wiley & Sons, Ltd. [source] Development of a client-generated health outcome measure for community nursingAUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH, Issue 5 2000Rhonda Griffiths Objective:To develop a client-generated outcome measure for use in community nursing. Method:Participants for the study were identified from the case load of community health nurses, from a nursing home service and from residents of a retirement village. All participants had a diagnosis of venous leg ulcer (VLU) and/or type 2 diabetes. Preliminary development of the measure involved focus groups of community clients and health professionals, and pilot testing of an existing quality of life (QoL) measure, the Patient-Generated Index. The resulting Client-Generated Index was tested for reliability and validity. Results:The Pearson's correlation coefficient between administration of the CGI at T1 and T2 was 0.526 (n=51; p=0.0001). The CGI correlated significantly with four of eight dimensions of the SF-36, and with pain as a clinical marker for VLU r=0.54 (p=0.001). Overall, participants with VLU reported a lower QoL (mean CGI score 2.8) compared to those with diabetes (mean CGI score 4.1). Conclusions:The CGI was developed to measure outcomes in community health settings. Some measures of its reliability and validity are demonstrated and further research is needed to validate the instrument using other client groups. Implications:If routine assessment and evaluation is to contribute to measures of outcome, the instruments need to be concise and acceptable to health care providers. The CGI has all these properties. [source] The first case of cutaneous mucormycosis caused by Rhizopus azygosporusBRITISH JOURNAL OF DERMATOLOGY, Issue 2 2005A. Fujimoto Summary A rapidly enlarging leg ulcer appeared in a 54-year-old woman with systemic lupus erythematosus receiving aggressive immunosuppressive therapy. Skin biopsy revealed proliferation of hyphae in the midst of a neutrophilic abscess. Culture yielded Rhizopus azygosporus. As no organ involvement was detected by thorough examination, the patient was diagnosed as having primary cutaneous mucormycosis. Although intravenous amphotericin B therapy seemed to be very effective, it had to be discontinued due to nephrotoxicity. She unfortunately died of subsequent disseminated fungal infection and cerebral infarction in which the primary cause could not be determined. Minimum inhibitory concentrations of several antifungal drugs to the isolate were examined and amphotericin B proved to be the only agent that may potentially reach the effective plasma concentration. This is the first case report of cutaneous mucormycosis caused by R. azygosporus. [source] An extensive painful leg ulcer in a patient with rheumatoid arthritisCLINICAL & EXPERIMENTAL DERMATOLOGY, Issue 3 2010W. P. Tan No abstract is available for this article. [source] Characterization of the polysensitized patient: a matched case,control studyCONTACT DERMATITIS, Issue 1 2009Berit Christina Carlsen Background: Polysensitization ( , 3 contact allergies) may be regarded as a special entity in patients with contact allergies. However, this group of polysensitized patients is poorly characterized. Filaggrin mutations are associated with atopic eczema and lead to impaired skin barrier which may predispose to contact allergy. Therefore, it is of interest to consider atopic eczema and contact allergies, especially in patients with multiple allergies. Objective: To characterize polysensitized patients regarding occurrence, duration and course of dermatitis, and examine potential risk factors for polysensitization, including atopic eczema. Methods: A questionnaire case,control study of 562 polysensitized and 1124 single/double-sensitized individuals was performed. Results: The results show that 45% of polysensitized and 31% of single/double-sensitized patients had or had had atopic eczema, and atopic eczema was identified as a risk factor for polysensitization. Patients with leg ulcer constituted only a minor part of the polysensitized group and leg ulcers were not identified as a risk factor for polysensitization in this study. The influence of contact allergies on duration and course of disease diverged between the group of patients with atopic eczema and the group without atopic eczema. Conclusion: Patients with atopic eczema were overrepresented in the group of polysensitized patients and polysensitized patients should be viewed in the light of occurrence or lack of atopic eczema. [source] Allergic contact dermatitis to rubber-containing bandages in patients with leg ulcersCONTACT DERMATITIS, Issue 6 2008Mariana Cravo No abstract is available for this article. [source] Intracutaneous injection of the macrophage-activating lipopeptide-2 (MALP-2) which accelerates wound healing in mice , a phase I trial in 12 patientsEXPERIMENTAL DERMATOLOGY, Issue 12 2008Margarete Niebuhr Abstract:, Chronic skin ulcers, such as leg ulcers, pressure sores and diabetic foot ulcers, are a challenge to physicians and medical personnel and a cause of tremendous discomfort and ensuing loss of quality of life to the patients. Wound healing involves production and action of various growth factors. A novel approach, distinct from the application of single growth factors, is the administration of the macrophage stimulator macrophage-activating lipopeptide-2 (MALP-2). The rationale is based on the finding that macrophages are the main source of several growth factors required for wound healing, which are sequentially released during this process. MALP-2 has previously been shown to be effective in an established animal model with diabetic mice. The purpose of the present phase I study was to establish tolerability of MALP-2 when applied into small cutaneous wounds in human beings. Twelve patients (six females and six males; mean age 66.8 years; range 52,87 years) with different diagnoses were enrolled into the study. An artificial wound was created with a 2-mm diameter skin biopsy punch and a volume of 30 ,l MALP-2 (0.125,1 ,g) or vehicle control, respectively, was injected intracutaneously into the wound and closed with a water-resistant transparent adhesive. Photos were taken daily from every patient up to 6 days, and skin biopsies were performed after 1 week from six patients. We could show in the present study for the first time that MALP-2 caused a transient erythema and was tolerated without any systemic side effects up to a dose of 1 ,g per wound in human beings. In healthy as well as in diabetic patients, MALP-2 induced local inflammation that faded after 48 h. The effectiveness of MALP-2 in the healing of chronic wounds in humans, e.g. in chronic skin ulcers, such as leg ulcers, pressure sores and diabetic foot ulcers, could now be addressed in further studies. [source] Leg ulcers and hydroxyurea: report of three cases with essential thrombocythemiaINTERNATIONAL JOURNAL OF DERMATOLOGY, Issue 12 2002Zeynep Demirçay MD Case 1,A 65-year-old woman with essential thrombocythemia (ET) had been taking oral hydroxyurea (HU), 1000 mg daily, for 7 years. Six months ago, she developed an ulcer on the outer part of her left ankle, which healed spontaneously within 2 months. She presented with a new, tender, shallow ulcer, 2 cm × 2 cm in size, at the same site. Doppler examination revealed thrombosis of the left common femoral vein and a calcified atheroma plaque of the left common femoral artery. The dosage of HU was decreased to 500 mg daily when the platelet counts were found to be within normal levels. The ulcer completely healed within 2 months with occlusive wound dressings, and has not recurred within the follow-up period of 1 year. Case 2,A 56-year-old women presented with multiple, painful, leg ulcers of 1 year duration. She had been diagnosed as having ET and had been on HU therapy, 1500 mg/day, for the past 5 years. Interferon-,-2b was started 3 months ago, in addition to HU, which was tapered to 1000 mg daily. She had suffered from hypertension for 20 years treated with nifedipine and enalapril, and had recently been diagnosed with diabetes mellitus which was controlled by diet. Examination revealed three ulcers located on the lateral aspects of both ankles and right distal toe. Arterial and venous Doppler examinations were within normal limits. Histopathology of the ulcer revealed nonspecific changes with a mixed inflammatory cell infiltrate around dermal vessels. The ulcers completely healed within 10 weeks with topical hydrocolloid dressings. After healing, she was lost to follow-up. A year later, it was learned that she had developed a new ulcer at her right heel, 3 months after her last visit (by phone call). This ulcer persisted for 8 months until HU was withdrawn. Case 3,A 64-year-old woman with ET presented with a painful leg ulcer of 6 months' duration. She had been taking oral HU for 5 years. She had a 20-year history of hypertension treated with lisinopril. Examination revealed a punched-out ulcer of 2 cm × 2 cm over the right lateral malleolus (Fig. 1). Doppler examination of the veins revealed insufficiency of the right greater saphenous and femoral veins. Angiography showed multiple stenoses of the right popliteal and femoral arteries. As her platelet count remained high, HU was continued. During the follow-up period of 13 months, the ulcer showed only partial improvement with local wound care. Figure 1. Punched-out ulcer surrounded by an erythematous border over the right malleolus (Case 3) [source] Foetal haemoglobin in homozygous sickle cell disease: a study of patients with low HBF levels*INTERNATIONAL JOURNAL OF LABORATORY HEMATOLOGY, Issue 5 2001A. Donaldson High foetal haemoglobin (HbF) levels are believed to ameliorate the manifestations of homozygous sickle cell (SS) disease. The corollary implies that patients with low HbF levels should have more severe clinical courses. We investigated this in a retrospective study of 50 Jamaican patients with steady-state HbF levels below 1% compared with a control group (A) of 54 subjects with steady-state HbF levels between 2.5 and 3.4% (around the 25th centile for our population), and a second control group (B) of 60 patients with steady-state HbF levels between 4.6 and 5.2% (around the 50th centile). Comparisons across the groups indicated significantly fewer females in the study group (16, 50 and 57%, respectively). Examination for haematological trends across the groups showed positive linear trends for haemoglobin (Hb) (P=0.004), packed cell volume (PCV) (P=0.01), mean cell volume (MCV) (P=< 0.001), mean cell haemoglobin (MCH) (P=< 0.001) and a negative trend for haemoglobin A2 (P=0.03). Clinically, there were no differences in the incidence of painful crises, abdominal crises and the acute chest syndrome, but leg ulcers were significantly less frequent in the study group (P=0.04). Therefore low HbF levels do not appear to increase the clinical severity of SS disease and may be protective against leg ulceration. [source] Venous leg ulcers: patient concordance with compression therapy and its impact on healing and prevention of recurrenceINTERNATIONAL WOUND JOURNAL, Issue 5 2009Christine Moffatt ABSTRACT This study aimed to review available data on the reasons attributed to patient non concordance with compression therapy for the treatment of venous leg ulcers (VLUs), the frequency of non concordance and its effects on clinical outcomes. The biomedical literature was searched for publications on VLUs, compression therapy and concordance over the past 20 years. Physical, aesthetic and cosmetic factors, patient lack of education about VLUs, cost of therapy and issues with treatment by clinicians were all reported to influence concordance with compression therapy. The search identified 10 studies reporting patient concordance with compression stockings or bandages; while non concordance ranged from 2% to 42% of patients in three randomised controlled trials, it was generally higher in real-world studies, ranging from 9.7% to 80%. Another set of six studies indicated that the healing rate was half and the median time to complete healing was twice as long when patients were not concordant. Further, recurrence rates were 2,20 times greater when patients did not comply with the use of stockings following VLU healing. In conclusion, published biomedical literature has documented that non concordance with compression therapy negatively impacts the outcome of VLUs, highlighting the need to improve patient concordance to maximise therapeutic benefits. [source] Evaluation of the nano-oligosaccharide factor lipido-colloid matrix in the local management of venous leg ulcers: results of a randomised, controlled trialINTERNATIONAL WOUND JOURNAL, Issue 2 2008Jean-Luc Schmutz Abstract The nano-oligosaccharide factor (NOSF) is a new compound aiming to promote wound closure mainly through inhibition of matrix metalloproteinase (MMP) activity. This factor is incorporated within a lipido-colloid matrix (Techonology Lipido-Colloid-NOSF matrix) and locally released in the wound. The objective of this study was to document the performance (non inferiority or superiority) of the NOSF relative to the Promogran® matrix (oxidised regenerated cellulose, ORC) effect in the local management of venous leg ulcers (VLUs). This was a 12-week, open, two-arm, multicentre, randomised study. Patients were selected if the area of their VLU [ankle brachial pressure index ,0·80] ranged from 5 to 25 cm2 with a duration ,3 months. Ulcers had to be free from necrotic tissue. In addition to receiving compression bandage therapy, patients were randomly allocated to either NOSF matrix or ORC treatment for 12 weeks. The VLUs were assessed on a weekly basis and wound tracings were recorded. Percentage wound relative reduction (%RR) was the primary efficacy criterion. Secondary objectives were wound absolute reduction (AR), healing rate (HR) and % of wounds with ,40% reduction compared with baseline. A total of 117 patients were included (57 NOSF matrix and 60 ORC). Mean population age was 71·3 ± 13·5 years, body mass index was ,30 kg/m2 in 39·3% and 15·4% were diabetics. Fifty-six per cent of the VLUs were present for >6 months, 61% were recurrent and 68% were stagnating despite appropriate care. Mean wound area at baseline was 11·2 ± 7·4 cm2. At the last evaluation, mean difference between the groups for %RR was 33·6 ± 15·0% in favour of NOSF matrix with a unilateral 95% confidence interval (CI) lower limit of 8·6% not including the null value. Therefore, a superiority of NOSF matrix effect compared with ORC was concluded (P = 0·0059 for superiority test). The median of the wound area reduction was 61·1% and 7·7% in the NOSF matrix and control groups, respectively (per-protocol analysis), or 54·4% versus 12·9% in intent-to-treat analysis (p = 0·0286). Median AR was 4·2 cm2 in the NOSF group and 1·0 cm2 with ORC (P = 0·01). Median HR was ,0·056 and ,0·015 cm2/day in NOSF and ORC groups, respectively (P = 0·029). By logistic regression, the NOSF versus control odds ratio to reach 40% area reduction was 2·4 (95% CI: 1·1,5·3; P = 0·026). In the oldest and largest VLUs, a strong promotion of healing effect was particularly observed in the NOSF matrix group compared with the control group. NOSF matrix is a very promising option for the local management of chronic wounds, especially for VLUs with poor healing prognosis. [source] Dystrophic calcification as a cause for non healing leg ulcersINTERNATIONAL WOUND JOURNAL, Issue 2 2005Article first published online: 28 JUN 200 Calcifications dystrophiques comme cause de non cicatrisations d'ulcères de jambe Malgré les avancées en biologie moléculaire et un répertoire d'autres optiosn thérapeutiques, les ulcères de jambe chroniques restent un problème significatif dans notre société.Il y a un certain nombre de raisons variées, locales et systémiques, qui contribuent à l'état de non cicatrisation de ces plaies. Parmi elles, les calcifications dystrophiques ( CD) ou les dépôts calciques dans le lit de l'ulcère, bien que rares, est un problème récurrent rare très décrit. En présence de CD, la cicatrisation ne peut se faire selon un processus chronologique ordonné et il en résulte un ulcère de jambe;Dans ce papier, nous discutons l'étiologie, la physiopathologie et les options de prise en charge de ces conditions rarement rapportées; Nous rapportons également leur pronostic clinique par une série de pateints porteurs d'ulcères de jambe chroniques compliqués de CD antraînant des difficultés de cicatrisation Dystrophe Kalzifikation als Ursache nichtheilender Fußulzerationen Obwohl die Molekularbiologie Fortschritte erzielt hat und ein größeres Spektrum an therapeutischen Möglichkeiten zur Verfügung steht, gehören chronisch venöse Fußulcera zu den bedeutensten Problemen unserer Gesellschaft. Es gibt verschiedene Gründe, sowohl lokaler als auch systemischer Genese, die zu einer ausbleibenden Heilung beitragen. Mögliche Ursachen sind dystrophe Kalzifikationen (DC) oder Kalkablagerungen im Wundbett. Obgleich deren Vorkommen gering ist, werden diese oft übersehen und finden in der Literatur nur selten Beachtung. Bei Vorliegen einer DC kann keine zeitgerechte oder adäquate Wundheilung stattfinden und es resultiert ein nicht abheilendes Ulkus. In dieser Abhandlung wird die Äthiologie, Pathophysiologie sowie therapeutische Möglichkeiten dieser selten berichteten Ursache diskutiert. Darüber hinaus wird die klinische Prognose von Patienten mit venösen Ulzera und komplizierter Wundheilung aufgrund einer DC erläutert Calcificazione distrofica come causa di ulcere delle gambe che non guariscono Nonostante il progresso della biologia molecolare ed il repertorio di altre opzioni terapeutiche, le ulcere venose croniche degli arti inferiori rimangono un problema significativo della nostra società. Esistono varie cause, sia locali che sistemiche, che contribuiscono alla propensione verso la mancata guarigione di queste ulcere. Tra queste la calcificazione distrofica (DC) o il deposito di calcificazioni all'interno del fondo di ferita, sebbene raro, è un reperto sottostimato e spesso all'origine delle lesioni. In presenza di DC, la riparazione tessutale non può procedere verso un percorso ordinato e temporale. In questo lavoro, abbiamo discusso l'eziologia, la patofisiologia e le opzioni di gestione di questa condizione raramente segnalata. Riportiamo inoltre la prognosi clinica utilizzando una serie di pazienti con ulcere venose complicate da DC verso una guarigione ritardata. La calcificación distrófica como causa del retraso de la cicatrización en úlceras vasculares A pesar de avances en biología molecular y un conjunto de otras opciones terapéuticas, las úlceras vasculares venosas crónicas siguen siendo un problema significativo en nuestra sociedad. Existen varios motivos, tanto locales como sistémicos, que contribuyen al retraso en el proceso de cicatrización de tales heridas. Entre ellos, la calcificación distrófica (CD), o depósitos calcificados dentro del lecho ulceroso, es una causa rara descrita en contadas ocasiones. En presencia de una CD, la curación de la herida no puede evolucionar favorablemente, con el resultado de la no cicatrización de la úlcera. En este trabajo discutimos la etiología, la fisiopatología y las opciones terapéuticas de este proceso que se describe en raras ocasiones. También informamos de su pronóstico clínico utilizando una serie de pacientes con úlceras venosas complicadas por CD, que conlleva dificultades para su cicatrización. Dystrofisk kalcifiering som orsak till icke-läkande bensår Trots framsteg i molekylärbiologi och en repertoire av andra terapeutiska möjligheter kvarstår kroniska bensår som ett betydande problem i vårt samhälle. Orsakerna som bidrar till den icke-läkande karaktären av dylika sår är varierande, de är både lokala och systemiska. Bland annat är dystrofisk kalcifiering (DC) eller kalcifierade depositioner i sårbädden, även om sällsynt, en förbisedd och sällan rapporterad orsak. Sårläkning kan inte framskrida i tidsenlig ordning i närvaro av DC och resulterar i ett icke-läkande sår. I detta paper, diskuterar vi etiologi, patofysiologi och behandlingsmöjligheter av detta sällan rapporterade tillstånd. Vi redogör också för den kliniska prognosen med hjälp av en serie patientfall av venösa ulcera med DC komplikation som lett till läkningssvårigheter. [source] Changes in quality of life for patients with chronic venous insufficiency, present or healed leg ulcersJOURNAL DER DEUTSCHEN DERMATOLOGISCHEN GESELLSCHAFT, Issue 11 2009Regina Renner Summary Background: Patients with chronic leg ulcers are handicapped in daily life, both by physical complaints and social problems. The aim of our study was not only to assess a possible impairment of quality of life (QOL) of leg ulcer patients but also to evaluate if there is a real improvement of QOL after healing of the ulcer. Patients with chronic venous insufficiency served as the control group. We further analyzed if there were significant differences in the response between patients who were and were not performing compression therapy. Patients and method: We interviewed three groups of patients (active venous leg ulcer, healed venous leg ulcer and patients with chronic venous insufficiency using the ,Freiburger Life Quality Assessment für Venenerkrankungen" (FLQAv). Results: Physical problems, daily handicaps and social problems all increased with age. Contrary to our expectations, healing of a leg ulcer did not lead to a significant increase in QOL. Instead, patients with active ulcers did not regard their QOL as lower than those in the other groups. Compression therapy also did not impair QOL in the three groups. Conclusion: Even though ulcer healing is an admirable goal, it does not necessarily lead to an improved QOL, probably because of the numerous comorbidi-ties in this patient group. Nonetheless, it is important to control problems associated directly with the wound to allow ulcer patients to participate actively in everyday life and minimize social problems. [source] | ||||||||||||||||||||||||||||